Blood Glucose Monitoring Optimizing

There are two important reasons for optimizing diabetes control:

the first is to eliminate symptoms, and the second is the longerterm
aim of aborting the development of diabetic complications.
 

Before embarking on complex programmes, it is essential to have
a clear view of the requirements of each individual patient. The
malaise associated with poorly controlled diabetes almost always
responds to better treatment with considerable improvement in
well-being. 

Occasionally, those whose control has been
persistently poor for very long periods may for a time feel less
well when blood glucose levels are reduced and consequently are
at first reluctant to make the effort to improve control.
 

Blood glucose measurementEquipment

• A spring-loaded finger pricking device.
• A blood glucose meter and test strips.
• For some, a blood ketone meter combined with a blood
glucose meter and test strips.

Note: The MiniMed Continuous Glucose Monitoring System
measures interstitial glucose levels every 10 seconds using a
sensor inserted under the skin of the abdominal wall; and
 

Glucowatch worn on the wrist is a new technique which
repeatedly measures subcutaneous glucose levels. They are still
expensive, and more experience in ascertaining their reliability
is needed before recommending them for routine use.
 

Purpose

• Spot check to detect hypoglycaemia or impending
hypoglycaemia.
• Assess control at times of illness.
• Assess blood glucose profile over 24 hours in order to
achieve ideal diabetic control.
Apart from the first two indications, isolated blood glucose
readings are of little value for optimising control.
Timing and frequency of testing for blood glucose
profiles for Type 1 diabetes
• One or two tests should be performed each day as a routine
for stable patients.

• Tests should be done at different time points each day to
build up a profile over several weeks 

• A 12-hour profile can be measured on a single day from time
to time, taking recordings before meals (four times a day), one
to two hours after meals (three times a day) and at bedtime.
Occasionally it helps to record a reading around 3 am.

Detecting and eliminating hypoglycaemia (see also chapter 8)
Measurement of blood glucose by patients themselves, or by
their relatives, when hypoglycaemia is suspected is the only way
of establishing whether or not the blood glucose is actually low.

This is of particular value in the assessment of children during
periods of bad behaviour, unconsciousness or convulsions.

Prediction of hypoglycaemia and therefore prevention is also
valuable especially at vulnerable times, notably mid-morning,
and at bedtime. Methods of reducing the risks of
hypoglycaemia are described in chapters 5 and 8.